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Stress management

Dealing With Depression

Battling the black bear

No facile definition can convey the wretchedness that is clinical depression. Those who have not fled screaming down the dark caverns of the mind find it hard to comprehend the despair and seeming impossibility of overcoming these terrifying and numbing feelings by sheer force of will.

There is no other serious illness whose sufferers are expected to heal by ‘looking on the bright side.’ Part of what makes depression so dispiriting is the inability of other people to understand the pain it causes. To family and friends (and even some doctors) it is something that the sufferer needs to ‘snap out of.’ I wonder how many patients with epilepsy or high blood pressure are told they should snap out of their condition and get on with life.

After publishing Bent Not Broken, my own struggles became well known and a large number of people sought me out to discuss and seek treatment for this mental illness.

I have been on both sides of the prescription pad; this doctor has been, and is still, a patient - a sensible one at times, but at other times unwise. One thing I know first-hand is the singular determination that grips someone bent on suicide, and the paradoxical euphoria and calm that accompanies the decision to find a final refuge from everything.

Such euphoria can make it difficult to recognise that a person is depressed by outward signs alone - that’s why listening closely to them is so vital. Earlier in the book I mentioned the death of my friend Cookie. A talented young rugby player, he hanged himself one night after a party. His death, and our too-late awareness of his unhappiness, was a dumbfounding blow.

What is perhaps a universal by-product of depression is shame. For me it went further, and was a source of my urge to self-destruct. My suicide attempt and my addiction to sleeping pills indicated my desire to find in sleep a kind of death.

My depression, the black bear, visits in cycles, growling in winter and when the wind unsettles it, at times quiescent as if in hibernation. But depression can be overcome.

One thing I have learnt is that it is important to acknowledge the patterns of behaviour that keep us depressed. When I recognized that I had, like my mother, fallen into the trap of addiction, I learnt an important lesson. When I acknowledged my habit of hanging on (at work, in relationships) until things reached breaking point, I began to understand that my behaviour was lessening my chances of finding happiness.

Depression is a battle and I am still learning to climb back up when it drags me down. The love of my son Paulie has made it easier, as has the love of friends and family. If only love alone could keep the black bear at bay.

Depression must be one of the least understood and most under-rated illnesses of our time. It’s a word bandied about by many people. “Oh, I was so depressed when Shortland Street went off air for summer.” “I can’t fit my size 16 jeans any more. How depressing.” So many people use the word as a substitute for ‘sad’, ‘annoyed’ or ‘disappointed’, that the condition itself is viewed less seriously than it should be.

Depression is not a fleeting sense of sadness or annoyance, nor just a bad-hair day. It’s a serious illness and can be as life-threatening as heart disease, diabetes and cancer. Depression kills people through suicide: so-called accidents at work, home, or on the roads; self-neglect; and increased risk-taking. It lowers quality of life by destroying self-esteem, motivation, energy levels and the ability to have fun. We have become used to shaking our heads over horrifying youth suicide statistics - well, a great many of these casualties are caused by depression.

I’ve had depression for most of my life. At its most severe it is among the worst illnesses I have come across in my experience as a GP seeing sick people every day. There’s no blood test, no plaster cast or wheelchair, no x-ray or scar that can show just how badly depressed someone is. People seriously ill with other conditions may be admitted to hospital, where they’re connected to tubes and monitors. Cards and flowers, hushed visitors and medical attendants all show that these people are ill; that they need our support and care.

Someone with severe depression doesn’t get this attention. They lug their hidden sickness around with them, trying to be happy and well for the sake of others, who just don’t understand what it’s like to try to get through a day full of mental pain and negativity. William Styron in his eloquent book Darkness Visible describes depression as a bed of nails, which its sufferers carry everywhere.

Depression has many physical symptoms, and has been called ‘the great mimicker’, as it can resemble lots of serious physical disorders. Some of the most distressing features to the person with depression, though, are the sense of failure and self-hatred that the illness brings. Just as its symptoms merge and dance with the symptoms of many other complaints (making depression and its sidekicks hard to diagnose), its treatments vary in their effectiveness.

An earlier version of part of these notes appeared in an article I wrote for my column in Bella magazine. The column evidently struck a chord with readers; many wrote and commented about it. One correspondent asked about depression as suppressed anger and the relationship between depression and violence. Another wanted to know the role of marijuana in depression: did it help short-term, long-term, not at all, or perhaps exacerbate it?

Some therapists believe that depression is related to repressed or internalised anger; that people who become depressed do so because they turn their anger at the world in on themselves. I think this is a valid analysis. Suicide, the end of depression for too many people, is the ultimate expression of violence directed at oneself. One of the signs of depression can be an increasingly short temper, and violence - especially towards children - can be a sign of depression in a parent.

Marijuana is used by a lot of people as an antidote to stress and depression. Some people find it helpful short-term, especially as a stress-buster. Long-term though, it tends to reinforce the lethargy and lack of motivation that are so common among people who are depressed. Marijuana may also unmask more serious mental illness in someone who is already predisposed to it. If you use it, do so with caution.

Getting my story down on paper has been a significant part of my salvation. I have found writing extremely therapeutic. It enables me to put thoughts and memories that are jangling around in my brain, out of my head and onto the page. When they’re out of my head I can get a new perspective on them, and can walk away from them if I choose. My mind is cleared and has space for more enjoyable thoughts.

Writing enables me to define my own reality and exercise some control over it. Through writing down my past, I have sifted through deeply buried memories and feelings, reliving my history. Through putting it on paper, my attitude toward my past has changed from one of helplessness to one of power. It’s mine, I own it. Writing has been an effective therapy for me because it’s constantly available and needs no one else to make it happen other than me. Through writing and then publishing my story, I have been able to accept the past and move forward.

When my first book came out I was terrified, laid bare, open, raw, my most painful secrets available for public scrutiny. But as people began to read the book I received more and more positive feedback. People have expressed admiration for my courage and honesty as they related to different aspects of the story. There is a saying by poet Muriel Rukeyser I like, “The world is made up of stories, not atoms.” I told my story and so far have witnessed reactions from empathy and admiration through to scepticism and scorn, but other people’s reactions have not changed the truth I have told.

I’m not cured or ‘over it’. I write it all down and, when necessary, seek additional help through counselling and anti-depressants. My anger is a fuel for action. I can’t pretend that everything is wonderful now. But I am changed, stronger than ever, and know which tools to use to help my healing.